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View targeted probe and educate (TPE) round results for wound care (CPT 11042 and 11045).
TPE is one process that a MAC can utilize when providers are selected by medical review.
This checklist is being provided as a tool to assist providers when responding to medical record documentation requests for major hip and knee joint replacement or reattachment of lower extremity (DRG 469 and 470) services.
Medical review of claims helps to ensure that Medicare pays for services that are covered, correctly coded, and medically reasonable and necessary.
This checklist is intended to provide health care providers with a reference for use when responding to additional documentation requests for Mohs micrographic surgery services.
View these guidelines regarding what it means for a service to be "reasonable and necessary."
The purpose of the open meeting is to allow interested parties the opportunity to make presentations of information and offer comments related to proposed local coverage determinations (LCDs) and/or the revised portion of a proposed LCD tha…
First Coast may consider coverage of a humanitarian use device, intended to benefit a small patient population, when the provider follows the specific guidelines and submits the appropriate documentation.
View this summary for outpatient rehabilitation services (December 2020).
Hospital outpatient departments (OPDs) who demonstrate compliance with Medicare coverage, coding, and payment rules related to prior authorization (PA) may be eligible for exemption. This exemption would remain in effect for a 12-month peri…